Athletic Pubalgia (AP or Groin Pain)

Question 1

Como é reportada a dor nos utentes com AP (athletic pubalgia)?

Answer 1

The patient with AP will most of ten report insidious or noncontact related unilateral pain in the adductor region and/or lower abdominals. As the condition
worsens, symptoms may present bilaterally and refer into the testicular region (in males).

Question 2

Quais os desportos mais propícios ao desenvolvimento de AP?

Answer 2

The sport in which the athlete participates is likely to

be soccer, American or Australian Rules football, rugby, or hockey.

Question 3

Quais poderão ser fontes neuromusculoesqueléticas de dor na virilha?

Answer 3

These sources of groin pain may include but are not limited to hip osteoarthritis, femoroacetabular impingement, hip labral tear, lumbosacral pathology, pelvic or hip stress fracture, and true inguinal hernia. In fact, the hip may be the main source of referred pain to the groin and so hip pathology needs to be ruled out before a diagnosis of AP can be suspected.

Question 4

Que testes adicionais ao lower quarter screen (LQS) podem ser aplicados para descartar athletic pubalgia (AP)?

Answer 4

Repeated lumbar motion.
Thigh Thrust Test.
Sensitive tests of the hip: Flexion Adduction Internal Rotation Test (FADIR); Hip ROM; Patellar Pubic Percussion (PPP) Test; Fulcrum test.

Question 5

Quais as estruturas que devem ser palpadas em utentes com AP?

Answer 5

Based on moderate level research, it is recommended a detailed palpation of the pubic region including the pubic ramus and symphysis, the lower abdominals, and the adductor region with the intent of reproducing the patient’s complaint of pain.

Question 6

Que músculos devem ser submetidos a testes de força resistida?

Answer 6

We recommend resisted strength testing of the major muscle groups in the groin and lower abdominal region to include the hip (flexors, extensors, abductors, adductors) and abdominal (obliques, rectus abdominus) musculature. The clinician should take note of decreased strength compared to the uninvolved side, the ratio of abduction to adduction strength regardless of side tested, and perhaps more importantly, the reproduction of the patient’s pain with testing.

Question 7

Quais os testes específicos para utentes com AP?

Answer 7

Squeeze test (SN 49; SP 88; LR+ 4.08).
Single Adductor (SN 32; SP 88; LR+ 2.67).
Bilateral adductor (SN 65; SP 92; LR+ 8.13).
Active Straight Leg Raise (SN 87; SP 94; LRþ 14.5).

Question 8

Qual a sequência da avaliação em AP?

Answer 8

1) Patient history (including outcomes measures); 2) Observação (geral); 3) Triage and screening (rule out non-AP sources of pain); 4) Motion testing (AROM, PROM, acessory motion); 5) Palpation; 6) Muscle testing; 7) Specific special tests; 8) Physical performance measures.

Question 9

Como a AP é um síndrome, como devemos fazer a triagem de patologias mais sérias?

Answer 9

Signs of more serious pathology are referred to as “red flags” and generally, the first step in detecting red flags is a standardized medical questionnaire (should broach urological, gynecological, rheumatologic, oncologic, and inflammatory sources of groin pain including testicular seminoma, prostatitis, epididymitis, endometriosis, ankylosing spondylitis, inflammatory bowel disease, appendicitis, and genital herpes).
Other red flags include a history of trauma, fever, unexplained weight loss, burning with urination,
night pain, and prolonged corticosteroid use.

Question 10

O que vamos testar no lower quarter screen (LQS)?

Answer 10

An efficient way to begin to differentiate the many potential pain referral sources is through the lower quarter screening examination. Traditionally, the lower quarter screen consists of testing of dermatomes, myotomes, deep tendon reflexes, and possible upper motor involvement. Any screening exam should be composed of tests with high sensitivity.